The voters of Massachusetts are smarter than I gave them
credit for. They voted down the nursing staffing ratios law that was
before the state voters. The bill was endorsed by the Boston Mayor and
Senator Warren, both union hacks. This continues to leave California as
the only state with staffing limits.

CMS has released the final rule for the Physician Fee
Schedule. There was a slight increase in the money per RVS code but they
delayed until 2021 the controversial elements of getting rid of the EM codes an
only paying for a single office visit. for codes level 2-4. The law also
continues to reduce the payments to the hospitals for their ridiculous charges
for off campus facilities. The law will permit payment for video check in
with patients as well as the time to review a video or image sent in by a
patient. It adds more clinicians to the MIPS program and is removing 26
"quality" measures. The law also cuts payments for new drugs covered
under Medicare Part B. Starting in 2019 the rate of reimbursement will be
cut from 6% over cost to 3%. The AHA will sue regarding the site
neutral policies. Let us hope they spend a lot of money on this and
lose.

President Trump's administration is trying to put pressure on
the drug companies. The newest proposal is to to have some meds that now
must be OK with Medicare insurers may lose that protection if their prices are
raised over the consumer price index over a year. Obama had tried that in
2014 but bowed to pressure. The proposal would have insurers do step
therapy, try a cheaper drug before the more expensive one or not to give
protection to a drug that is merely a new formulation of an older drug such as a
timed release formulations. The administration said they would support a
law that would give these savings back to the consumer at the pharmacy
counter.

The FDA is planning on updating its medical device
approvals. They want to update the process that allows new products based
on similarities to older products and not doing new testing on patients prior to
approval. There has been no substantial updating of the approval process
since 1976. Top

Hospitals

The California Department of Justice
has approved the merger of Dignity Health and Catholic Healthcare Initiatives
now named Commonspirit Health. This new entity will have 140 hospitals in
16 states. They will be required to maintain emergency services and
women's healthcare services for 10 years and if they want to change these
services in years 6-10 they must get approval from the state. They also
must crate a Homeless Health Initiative in California to support the delivery of
treatment and services to the homeless. This includes $20 million over six
years to local communities to help the homeless with at least $10 million in the
firt three fiscal years. The hospitals will also be required to give free
there services to patients up to 250% of the federal poverty limit plus post financial
assistance policy on its website and throughout the hospitals.
The CEO of Dignity prior to the merger is Lloyd Dean. His salary was
reported to be over $8 million. Great charity. Top

Physicians

The Medical Board of California is now
going after 11 more physicians based on death records. The physicians are
accused of prescribing opiates and having the patients OD. This questionable
practice looks at OD deaths from many years prior.
Top

DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the
time of publication. Nothing in this article constitutes legal advice. Readers
should consult with their own legal counsel before acting on any of the
information presented.